Patients with acute coronary syndromes and elevated levels of natriuretic peptides: the results of the AVANT GARDE-TIMI 43 Trial
Key result
Early initiation of aliskiren, valsartan, or their combination did not significantly reduce NT-proBNP levels over 8 weeks compared with placebo (reductions of 44%, 39%, 36%, and 42%, respectively).
Why the study?
Does early inhibition of RAAS with aliskiren, valsartan, or their combination reduce NT-proBNP levels in patients stabilized after ACS with elevated NPs and preserved LV function compared with placebo?
Population
1101 patients stabilized after acute coronary syndromes without clinical evidence of heart failure or left…
Comparison
Aliskiren, valsartan, or their combination vs Placebo
Design
RCT, randomized, double-blind
Follow-up
8 weeks
Authors
Discussion
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Implication
Caution against early RAAS inhibition in stabilized post-ACS patients with preserved LV function; challenges expected NT-proBNP reduction.
Study Design
Type
RCT (n=1,101)
Blinding
double-blind
Randomization
randomized
Multicenter
Yes
Structured PICO
Does early inhibition of RAAS with aliskiren, valsartan, or their combination reduce NT-proBNP levels in patients stabilized after ACS with elevated NPs and preserved LV function compared with placebo?
P
Population
1,101 patients stabilized after ACS without clinical evidence of heart failure or LVEF ≤40% but with elevated natriuretic peptides, followed for 8 weeks.
I
Intervention
Aliskiren, valsartan, or their combination
C
Comparator
Placebo
O
Outcome
Change in NT-proBNP from baseline to Week 8surrogate
In post-ACS patients with elevated natriuretic peptides but preserved LV function, early RAAS inhibition did not provide additional NT-proBNP reduction over placebo and increased adverse events.
Cite This Study
Scirica et al. (2010) conducted an RCT in acute coronary syndromes (n=1,101). aliskiren, valsartan, or their combination vs. placebo was evaluated on change in NT-proBNP from baseline to Week 8. Early initiation of aliskiren, valsartan, or their combination did not significantly reduce NT-proBNP levels over 8 weeks compared with placebo (reductions of 44%, 39%, 36%, and 42%, respectively).